Provider Demographics
NPI:1346869765
Name:PRACTITIONERS ALLIANCE BEHAVIORAL
Entity type:Organization
Organization Name:PRACTITIONERS ALLIANCE BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:863-875-6063
Mailing Address - Street 1:7450 CYPRESS GARDENS BLVD STE 7504
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-6200
Mailing Address - Country:US
Mailing Address - Phone:863-875-6063
Mailing Address - Fax:863-875-6086
Practice Address - Street 1:7504 CYPRESS GARDENS BLVD STE 7504
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3200
Practice Address - Country:US
Practice Address - Phone:863-875-6063
Practice Address - Fax:863-875-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty